A rare case of complex orbital lymphangiohemangioma

Abstract

Background: To report an unusual case of ocular toxoplasmosis complicated by both retinal detachment and choroidal neovascularization in the same eye of an immunocompetent patient Results: A 74-year-old gentleman of oriental origin presented with a 3-month history of reduced vision in the left eye: best corrected visual acuity was 6/6 in the right eye and 6/24 in the left eye. Clinical examination revealed no signs of systemic illness. The anterior segment in the left eye showed pigmented granulomatous keratic precipitates. Anterior chamber was deep with 3+ cells; no hypopyon. Both eyes were pseudophakic with clear media. Posterior segment of the left eye showed dense vitritis, with 2 areas of retinitis. No retinal breaks were visible. Serum Toxoplasmosis antibodies IgM was negative, but IgG was positive at 3.584. Vitreous tap was negative for CMV, HSV1, HSV2, and VZV DNA. Vitreous PCR for toxoplasmosis was not available at the time. He was started on oral Prednisolone 1 mg/kg, oral Bactrim (Sulfamethoxazole and Trimethoprim), and topical prednisolone acetate 1% (PredForte) 4-hourly. Visual acuity in the affected eye was 6/9 at 8 weeks post initiation of treatment. He subsequently developed retinal detachment which was operated with a visual outcome of 6/18. Unfortunately, he then developed choroidal neovascularization, and despite anti-VEGF treatment, did not regain his vision.. Conclusion: Prompt diagnosis of atypical presentation of ocular toxoplasmosis may aid management and subsequent preservation of visual function.